Charles West (1816–1898): Pioneering paediatrician and midwifery advocate in the 19th century medicine

Midwifery encompasses obstetric and gynaecological services, including primary care, prenatal and obstetric care, and uncomplicated routine gynaecological care, contraception and newborn care. These practices have been passed down through generations. The practical and spiritual support of traditional birth attendants has made the difference between life and death. During the 18th century obstetrics, outside mainstream medicine, was marginalised. Midwifery was looked upon by physicians as totally beneath their high calling. The subject was learned by practice for the attendant. In 1843, the Royal College of Surgeons of England rejected all association with general practitioners and midwives attending births.1 However, a few doctors went abroad to study midwifery. Charles West (1816–1898) was one of the first who drew attention to the necessity of improvements in the practice of midwifery at a time when the establishment of inpatient hospitals stimulated interest in research into the care of pregnant women (Figure 1). He visited Dublin to study and train in midwifery. In 1852, Dr. West was the founder of the first paediatric hospital in the English-speaking world, The London Hospital for Sick Children in Great Ormond Street (GOSH). Charles West's dedication to setting up his children's hospital, together with his advocacy for hospital-based care influenced the professionalisation of both paediatric nursing and midwifery together with the importance of maternal care. He believed in better health outcomes for mothers and their children by promoting their safety, especially high-risk pregnancies.2 During the 14th–17th centuries, midwives in Europe began to face persecution and accusations of witchcraft, while early societies respected midwives as members of the community. This development coincided with the rise of male-dominated medical professions and attempts to control women's healthcare.1 This was a dark period for the midwifery profession forcing the profession to go underground. With advancements in obstetric practices, for example, the invention of obstetric forceps by the Chamberlen family in 1634, male midwives, or accoucheurs, played a more respected role compared to their predecessors, the barber-surgeons, who were often viewed unfavourably. Integration into Western medical practice during the 18th and 19th centuries was rather gradual. The establishment of formal training and examinations for male practitioners effectively excluded women, culminating in the Midwives Act of 1902, which mandated training for midwives and marginalised lay practitioners.3 The integration of midwifery into medical practice was inevitable by the early 20th century. As male midwives gained prestige, they became the preferred practitioners for the upper classes, while lay midwives served the working class. This shift diminished the status of female midwives, whose traditional knowledge was increasingly deemed inferior to the ‘scientific’ approaches of their male counterparts. This historical trajectory illustrates the complex interplay of gender, social class and medical authority in shaping midwifery practices. Charles West was the second son of a London Baptist lay preacher, educated at a school run by his father in Buckinghamshire and then initially trained as an apothecary and apprenticed to a general practitioner in Amersham. In 1833, he became a medical student at St. Bartholomew's Hospital, and 1836–1837 transferred his studies to Bonn, Paris, Heidelberg and Berlin, where he took his medical degree with a thesis on the female pelvis and its influence on parturition. He began work as a general practitioner in London, but went on to study midwifery in Dublin at the Meath Hospital in 1838.4 He was married twice, first with Miss Cartwright, with whom he had a son and a daughter; then, after her death, Marie Octavie Agatha Clotilde West, who died in 1923. His attempt to enter general medical practice in London in 1839 met with little success. Instead, he became physician to the Infirmary for Women and Children, Waterloo Road, in 1842, and began to lecture on midwifery at the Middlesex Hospital in 1845. This placement led to his continued involvement in the care of women and children. His lectures were published in the Medical Gazette initially before being compiled as a book. Diseases of Women went through four editions where he exhibited the fundamentals of experiential learning, recounting details of each case as he applied basic scientific knowledge of medicine to practice.5 He collaborated with James Mathews Duncan (1826–1890) on his scholarly works, which were translated into several European languages. He held the post in midwifery for 12 years, while serving in various other capacities in medicine. In 1848, he published a course of lectures on Diseases of Infancy and Childhood, which reached a seventh edition, and was widely translated. From that year until 1861, he was lecturer on midwifery at St. Bartholomew's and the publication of his lectures on Diseases of Women in 1856 were met with a similar success. At a time when much of the medical establishment argued against the need for paediatric hospitals, Charles West was aware of the urgent need for inpatient facilities for sick children and the importance of specialist treatment for children in London. At that time, Europe had 17 children's hospitals with growing success and value. West visited these hospitals to elaborate their relevance and effect. In 1852, the London Hospital for Sick Children at 49 Great Ormond Street was opened (Figure 2), thanks to the provisions committee which was made up of nine men including Dr. Henry Bence-Jones (1813–1873). The founder's intention was to provide medical treatment for the poor children, to advance medical science with reference to childhood diseases and to achieve management of ill children and educate women in children's nursing. Thus, West overcame both resistances and prejudices of Victorian society towards a hospital exclusively dedicated to sick children.6 The establishment of the GOSH underscores the importance of interprofessional collaboration in healthcare. Apart from advancing the field of sick children and paediatrics, his work set a precedent in ensuring a longitudinal approach by integrating midwifery and obstetric care as a cohesive work bundle. West's commitment to educational initiatives extended to training healthcare professionals in collaborative practices between physicians and nurses in caring for sick children of the poor within the hospital. This approach laid the groundwork for teamwork among healthcare providers with continuity of contemporary practices in pregnancy, childbirth and early childhood. His personal involvement with the community in sourcing for funds from community leaders is an example of pooling all stakeholders, including allowing the families of the sick children to visit them in the wards (Figure 3), which laid the groundwork for effective collaborative practice for a common good. With vast experience as a physician, obstetrician, paediatrician and hospital director, his book ‘On Hospital Organization, with special reference to the organization of Hospitals for Children’ was published in 1877, showing his skills as an effective manager, apart from ensuring that a comprehensive health service must go beyond that of curing the ailment. West was aware of the importance of professional conduct, had a positive attitude, showed respect and clear communication. He protected the maternal environment not only by appropriate use of diagnostics and therapeutic remedies, but also through demonstrating a deep sensitivity to the needs of his patients.4 While making a huge move in justifying the need for institutional care of sick children, he emphasised the importance of the study of diseases of women from pathological states and the psychology of the mind. Approaching women's diseases with care and sensitivity was his mantra, as he urged his trainees to go beyond curing ailments to see the overall improvement in the healthcare system. Charles West re-drew the boundaries of responsibility in creating an interprofessional framework of collaborative intrapartum practice between midwives and other maternity care professionals to improve access and women's choices for maternity care.6 By the establishment of the first Children's Hospital, West paved the way for collaboration among obstetricians, midwives and paediatricians in promoting better health outcomes for mothers and children. Charles West was dedicated to the maternal environment and saving the lives of children. He realised that aligning the perspectives of midwifery and medicine is significant to effective implementation of collaborative intrapartum care. Coupled with his foresight in formally training nurses to care for sick children, he addressed the unique needs of mothers, including an extended and holistic approach, focusing on both emotional and psychological health of women and children. It illustrates the beginning of evidence-based medicine, the necessity for audits and the formalisation of nurse training.6 These were essential ingredients for effective maternal and child health services. West's work was based on respect for human dignity and compassion. He was the hospital's senior physician for 23 years. In 1877, following personal and policy differences with the management, he resigned from his position and spent the remaining 20 years of his life in practicing medicine in Nice, London and Paris—where he died in 1898 aged 82. Stefan Kutzsche: Conceptualization; writing – original draft; investigation; methodology; validation; writing – review and editing; resources. Sivalingam Nalliah: Conceptualization; investigation; writing – original draft; methodology; validation; writing – review and editing; resources. The authors declare no conflicts of interest.